The June International Psychogeriatrics Article of the Month is entitled “Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial” by Claudia Cooper, Julie Barber, Mark Griffin, Penny Rapaport and Gill Livingston. This blog piece was written for us by one of the paper’s authors, Claudia Cooper.

People with dementia are at increased risk of elder abuse. When we asked family carers of people with dementia whether they had acted in ways that could be abusive, such as screaming or shouting at the person, in a previous study a third said that they had sometimes done so in the last few months. Carers who were more stressed were more likely to act abusively. The START (Strategies for Relatives) intervention for family carers of people with dementia has been shown to reduce the levels of depression and anxiety they report over 2 years. Abusive behavior is associated with depression and anxiety, so we wondered whether START might also be effective in reducing abuse. In this study, we wanted to find out whether family carers who received the START intervention were acting abusively less frequently than carers who did not receive the intervention.

We recruited 260 carers. 173 received the START intervention and 87 did not receive any additional treatment. There was no evidence that those who received START abused less. This is the first randomized controlled trial with abusive behavior towards people with dementia as an outcome. Nearly half of the participants reported significantly abusive behavior at the start of the study and the START intervention did not decrease this compared to those receiving usual treatment. A quarter of carers still reported significant abuse after two years, but those not acting abusively at baseline did not become abusive.

What is the take home message? There was no evidence that START, which reduced carer anxiety and depression, also reduced carer abusive behavior. For ethical reasons we frequently intervened to manage concerning abuse reported in both groups, and may therefore have reduced abuse in the control group, masking any effect of the intervention. Future dementia research should include elder abuse as an outcome, and consider carefully how to manage detected abuse.